Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA,
Surg Endosc. 2014 Jan;28(1):178-84. doi: 10.1007/s00464-013-3150-x. Epub 2013 Sep 7.
Self-expandable metal stents (SEMS) and self-expandable plastic stents (SEPS) maybe used for the treatment of benign upper gastrointestinal (GI) leaks and strictures. This study reviewed our experience with stent insertions in patients with benign upper GI conditions.
Patients who underwent stent placement for benign upper GI strictures and leaks between March 2007 and April 2011 at a tertiary referral academic center were studied using an endoscopic database and electronic patient records. The technical success, complications, and clinical improvement after stent removal were compared according to type of stent. The outcomes measured were clinical response, adverse events, and predictors of stent migration.
Thirty-eight patients (50 % male, mean age = 54 years, range = 12-82) underwent 121 endoscopic procedures. Twenty patients had stents placed for strictures, and 18 had stents placed for leaks. Stent placement was technically successful in all patients. The average duration of stent placement was 54 days (range = 18-118). Clinical improvement immediately after stent placement was seen in 29 of the 38 patients (76.3 %). Immediate post-procedure adverse events occurred in 8 patients. Late adverse events were seen in 18 patients. Evidence of stent migration occurred in 16 patients and was seen in 42 of the 118 successfully placed stents (35.5 %). Migration was more frequent with fully covered SEMS (p = 0.002). After stent removal, 27 patients were evaluable for long-term success (median follow-up time of 283 days, IQR 38-762). Resolution of strictures or leaks was seen in 11 patients (40.7 %). Predictors for long-term success included increasing age and if the stent did not cross the GE junction.
Placement of SEPS and SEMS for benign refractory strictures and fistulas has modest long-term clinical efficacy and is limited by a significant migration rate. Stent migration is common and frequent with fully covered SEMS compared to other types of stents, regardless of indication or location.
自膨式金属支架（SEMS）和自膨式塑料支架（SEPS）可用于治疗良性上消化道（GI）漏和狭窄。本研究回顾了我们在良性上消化道疾病患者中进行支架置入的经验。
使用内镜数据库和电子患者记录，对 2007 年 3 月至 2011 年 4 月在三级转诊学术中心因良性上消化道狭窄和漏接受支架置入的患者进行研究。根据支架类型比较技术成功率、并发症和支架取出后的临床改善情况。测量的结果包括临床反应、不良事件和支架迁移的预测因素。
38 例患者（50%为男性，平均年龄=54 岁，范围 12-82 岁）接受了 121 次内镜检查。20 例患者因狭窄而放置支架，18 例患者因漏而放置支架。所有患者的支架置入均获得技术成功。支架置入的平均时间为 54 天（范围 18-118 天）。38 例患者中有 29 例（76.3%）在支架置入后立即出现临床改善。8 例患者在术后即刻出现不良事件。18 例患者出现迟发性不良事件。16 例患者出现支架迁移的证据，在 118 个成功放置的支架中，42 个（35.5%）可见支架迁移。完全覆膜的 SEMS 更常发生迁移（p=0.002）。支架取出后，27 例患者可进行长期疗效评估（中位随访时间 283 天，IQR 38-762）。11 例患者（40.7%）狭窄或漏得到缓解。长期成功的预测因素包括年龄增加和支架未穿过胃食管交界处。
SEPS 和 SEMS 治疗良性难治性狭窄和瘘管具有适度的长期临床疗效，但迁移率较高。支架迁移很常见，与其他类型的支架相比，完全覆膜的 SEMS 更为频繁，无论其适应证或位置如何。
